Information Collection

Collection of Qualitative Feedback on Telehealth.HHS.gov

IC 248260 under ICR 202312-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov	Form
Form 1 Telehealth Website - Page Level - SurveyEngSpan.docx Collection of Qualitative Feedback on Telehealth.HHS.gov	Form
Form 2 Telehealth Website - Site Level - Survey EngSpan.docx Collection of Qualitative Feedback on Telehealth.HHS.gov	Form
1 Telehealth Website - Page Level - SurveyEngSpan.docx Telehealth Website - Page Level - SurveyEngSpan.docx	Form
1 Telehealth Website - Page Level - SurveyEngSpan.docx Telehealth Website - Page Level - SurveyEngSpan.docx	Form
2 Telehealth Website - Site Level - Survey EngSpan.docx Telehealth Website - Site Level - Survey EngSpan.docx	Form
2 Telehealth Website - Site Level - Survey EngSpan.docx Telehealth Website - Site Level - Survey EngSpan.docx	Form
Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7.docx Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7	IC Document
Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7.docx Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7	IC Document

IC Title:

Collection of Qualitative Feedback on Telehealth.HHS.gov

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1				Yes	Yes	Fillable Fileable
Form	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,465

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	17,465	17,465
Annual IC Time Burden (Hours)	99	99
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Telehealth Website - GENERIC - Supporting Statement FINAL JULY 7		07/07/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].